# LIBERTY HEALTHCARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720332349
- **Authorized official:** DERK PARDOE (PARTNER)
- **Authorized official phone:** (801) 808-2357

## Contact information

- **Practice address:** 5589 GREENWICH RD, SUITE 175, VIRGINIA BEACH, VA 23462-6565
- **Practice address phone:** (757) 216-9115
- **Practice address fax:** (757) 216-9117
- **Mailing address:** 3454 E STONE MOUNTAIN LN, SANDY, UT 84092-6549
- **Mailing address phone:** (801) 808-2357

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 140177 | VA | Yes |

## Other

- **Enumeration date:** 11/05/2012
- **Last updated:** 11/05/2012